Dorset County Hospital is a district general hospital in the town of Dorchester, Dorset, England. The hospital is managed by Dorset County Hospital NHS Foundation Trust.
Inverted follicular keratosis (IFK) is an uncommon benign skin epithelial neoplasm that microscopically consists of a superficial, sharply circumscribed tumor composed of bland keratinocytes associated with squamous eddies. Only a few examples of combined tumors associating IFK and either trichoblastoma or a sebaceous component have been reported in the literature. Herein, we report the clinicopathological and molecular characterization of 12 cases of combined tumor comprising IFK associated with an adnexal neoplasm, including trichoblastoma (n = 7), sebaceoma (n = 4), and tubular adenoma (n = 1). The age at presentation ranged from 26 to 79 years, with a mean of 55 years. The majority of the tumors were located on the head (n = 8) with a median size of 6 mm (Range: 3–14 mm). Microscopically, all cases showed a biphasic appearance with a prominent IFK component superficially, associated either with trichoblastoma, sebaceoma or tubular adenoma at the deeper aspect, with an abrupt transition between the two tumor components. There was no evidence of nevus sebaceus in the surrounding tissue. Molecular investigation revealed pathogenic HRAS or KRAS mutations in 3 of the 4 cases harboring a sebaceous component and also in the specimen with combined IFK and tubular adenoma. No mutations were detected in any of the 5 tested IFK-TB cases. To conclude, our series expands the spectrum of combined tumors associated with IFK. Genetic characterization suggests that pathogenic mutations of RAS might drive a subset of these cases, particularly when associated with sebaceoma, even in the absence of pre-existing nevus sebaceus.
ABSTRACT:Facial papules (FPs) are asymptomatic, white-to-yellowish monomorphic papules that have been recently described as a clinical manifestation of frontal fibrosing alopecia. We present 9 cases of facial papules, emphasizing their subtle clinical and histopathological presentation which may be often overlooked.
BACKGROUND: Harnessing Lived Experience Expertise (LEE) and Clinical Expertise (CE) is essential for patient-centred research. Yet transparent reporting and critical reflection on their impact remain limited. This study details an iterative approach to integrating LEE and CE in the development of a preoperative therapy intervention for Dupuytren’s fasciectomy, evaluating their influence on study design and implementation. OBJECTIVE: To assess how LEE and CE shape intervention development, influence research decisions, and to identify associated challenges, successes, and best practice for integration into clinical research. METHODS: A structured, multi-phase approach is implemented using the GRIPP2 short-form, a validated Patient and Public Involvement reporting framework. Activities include forming a steering committee, engaging patients and clinicians in intervention development, co-creating study materials, and refining trial protocols. Feedback is gathered through online meetings, surveys, and direct consultations. A LEE contributor co-authors this study, ensuring patient perspectives were embedded throughout. RESULTS: Integrating LEE and CE leads to significant refinements in study design, including development of intervention content aligned LEE/CE priorities, clearer and more accessible patient-facing materials and outcome measures that reflect real-world patient concerns. Challenges include sustaining contributor engagement over time and balancing patient and clinician priorities. CONCLUSION: Embedding LEE and CE strengthens feasibility, and acceptability of intervention and research processes. Lessons learned emphasise the need for flexible, iterative engagement strategies and structured reporting to optimise involvement and enhance impact. Future work should explore how reporting frameworks support sustained contributor engagement and how LEE and CE shape accessibility, relevance and implementation of clinical research.
OBJECTIVE:To evaluate the incremental yield of clinically significant prostate cancer (csPCa) detected by systematic biopsy outside MRI-targeted lesions during cognitive fusion local anaesthetic transperineal prostate biopsy. PATIENTS AND METHODS:This observational cohort study included men undergoing cognitive MRI-targeted prostate biopsy with concurrent systematic sampling. Pre-biopsy MRI findings were recorded using PI-RADS. The primary outcome was csPCa detected exclusively by systematic biopsy outside MRI-targeted lesions despite a negative targeted biopsy. Secondary outcomes included csPCa detection by targeted, systematic, and combined biopsy, PI-RADS subgroup analysis, and multivariable predictors of csPCa. RESULTS:Overall, 770 men were included, of whom 767 had evaluable paired biopsy data. Most had PI-RADS 4 lesions (636/767, 82.9%). csPCa was detected by targeted biopsy in 320/767 men (41.7%), systematic biopsy outside MRI-targeted lesions in 196/767 (25.6%), and combined biopsy in 384/767 (50.1%). Exclusive outside-target systematic csPCa detection occurred in 64/767 men (8.3%), representing 16.7% of all csPCa detected. This rate was highest in PI-RADS 3 lesions (8/30, 26.7%). On multivariable analysis, overall csPCa detection was associated with age, PSA density, and PI-RADS score, whereas exclusive outside-target detection was inversely associated with PI-RADS score and positively associated with procedures performed by urologists. Spatial analysis showed that most systematic-only csPCa lesions were anatomically distinct from the index MRI-visible lesion. CONCLUSIONS:Systematic biopsy outside MRI-targeted lesions detected additional csPCa in 64/767 men (8.3%) and frequently identified anatomically distinct lesions, supporting continued systematic sampling alongside MRI-targeted biopsy in selected patients.
